Physical therapy is a hands-on profession. And I don’t mean that solely in the literal sense. Yes, the treatment we provide is distinctively hands-on, but so is our approach to problem-solving. Over the years, the PT community has faced a lot of challenges: market consolidation, dwindling reimbursements, restrictions to the type and quantity of care we can provide. And we’ve tackled those challenges head-on. But a couple of weeks ago, as I sat in the conference room where the 2018 Graham Sessions took place, I—along with many of my fellow attendees—realized that there is one challenge we’ve been tiptoeing around for decades. And as all PTs know, when a problem is left untreated for a long period of time, it becomes a bigger—and much more complex—problem. I’m talking about the lack of diversity in physical therapy.

During perhaps one of the most memorable discussions I’ve been part of over the course of my four-year tenure as a Graham Sessions participant, we came to some difficult realizations about not only our industry, but also ourselves. Specifically, we recognized that, whether or not we are aware of it, we are all influenced by our individual biases. These biases impact every single judgment, decision, and action—every single minute of every single day. And those hidden preferences and predispositions—along with any number of other environmental factors—have led to a pretty hard truth: 80% of physical therapists are white.

Now, while this particular session focused mainly on the unbalanced racial distribution of physical therapists in comparison to society as a whole, I believe it’s worth pointing out that this is only one facet of a much larger problem. After all, diversity encompasses much more than race: it also includes things like gender, sexual orientation, and religion—not to mention the intangible elements of cognitive diversity (e.g., education, social background, and personality type). But regardless of which diversity factor we’re talking about, the problem is the same: we are inherently biased toward people with certain characteristics and attributes, and often, those characteristics and attributes mirror our own.

But, as one speaker pointed out, the solution to this problem is not, in her words, “colorblindness.” In other words, we cannot simply ignore our biases or pretend they don’t exist. Instead, we must recognize and own them, because that’s the only way we can effectively navigate them. Furthermore, we must look at diversity as more than just a hiring issue, because as another attendee noted, the pool of candidates for any given position often isn’t diverse. And that speaks to a much more deeply rooted issue, one that requires us to examine what is happening at the educational level—and beyond.

So, what are the barriers—socially, economically, or even geographically—that are keeping some would-be physical therapy students from pursuing a career in our field? Is the crippling student loan debt—and seemingly incommensurate earning potential (at least compared to other, more financially lucrative healthcare disciplines)—turning certain segments of the student population away from PT? Or, are some young people less likely to be exposed to physical therapy because those in their immediate personal networks—their friends and family members—are less likely to seek care from a physical therapist?

When you consider all of this from the patient perspective, it really comes full circle. After all, it’s logical to assume that some patients may not feel comfortable seeking care from someone who doesn’t look like them—or who doesn’t align with their own cultural values. I think this concern is especially relevant in physical therapy, as successful treatment hinges on the formation of strong patient-provider relationships that help carry patients through their entire course of care—thus allowing them to achieve the best possible results. Because at the end of the day, we are treating more than muscles, joints, and ligaments; we are treating human beings. And as such, we must account for all the things that make us human—including our individual biases.

Our mission as physical therapists—as defined by the APTA vision statement—is to transform society. And while I—and others in the industry—have talked a lot about the longstanding physical therapy branding problem and how it’s preventing us from reaching all members of the population who could benefit from our care, I now realize that assessment is shortsighted. Yes, the physical therapy profession still needs a more cohesive brand—but it also needs a more inclusive composition. After all, as another speaker so astutely observed, “How can we transform society when our profession doesn’t look like society?” And perhaps I am biased, but I couldn’t agree more.

Curious as to what else we discussed at this year’s Graham Sessions? Be sure to check out my full recap here. Want to share your own perspective on the PT diversity issue? Leave a comment below. I’d love to keep the conversation going.

About the Author

Heidi Jannenga PT, DPT, ATC/L is the president and co-founder of WebPT, the leading practice management solution for physical, occupational, and speech therapists. Heidi leads WebPT’s product vision, company culture, and branding efforts, while advocating for the physical therapy profession on a national scale. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has since guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.

An active member of the sports and private practice sections of the APTA, Heidi advocates for independent rehab therapy businesses, speaks as a subject-matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. In 2014, Heidi was appointed to the PT-PAC Board of Trustees. She also serves as a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice rehab therapy professionals.

Heidi was a collegiate basketball player at the University of California, Davis, and remains a lifelong fan of the Aggies. She graduated with a bachelor’s degree in biological sciences and exercise physiology, went on to earn her master’s degree in physical therapy at the Institute of Physical Therapy in St. Augustine, Florida, and obtained her doctorate of physical therapy through Evidence in Motion. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.

Thanks Heidi for posting your recap of the Graham sessions, I have enjoyed reading your thoughts on the event as well as those from others in attendance. Hopefully I can have the privilege of attending one of these sessions in the future.

With regards to the diversity issue in our profession, I’m just curious to see if gender was discussed? Its hard to look at the data and not see that 70% of the profession is female. (Certainly not a surprise)

Hi Ryan
Yes we touched on the subject, but it centered more around a subject that I am passionate about which is “Cognitive diversity” and the panel represented more ethnic and cultural diversity. One of the best discussions on this topic ensued right here on this blog back a few years with a post from John Childs: http://www.evidenceinmotion.com/blog/2014/03/04/women-in-pt/

The comment about “colorblindness” was an important one that was made during this session at Graham Sessions. This session was a sleeper, that brought the most dialogue that for me anyway extended into the longer dialogue with colleagues than any session in my past 4 years attending the GS. I continued to this describe this session to colleagues back home, when asked; how was the Graham Sessions?” The goal here should not be some opaque, non-gender, non-sexual, non-religious orientation to achieving diversity. I hear in the human resources world that large companies are embracing the word “culture-add” to the diversity discussion. Carrying cultural biases is something we all carry with us into any work or treatment situation. It is something innate through our own upbringing in our own culture. Curious exploration of another persons culture, and valuing the person as someone who can help you become a fuller human being, can help us get to a higher level of personal growth and diversity.

Heidi…
This is an interesting perspective. But it caused me to pause regarding some of the assumptions.

I agree biases are inherent to every person…regardless of race, ethnicity, belief structure, sex and the lot. However, these are not necessarily negative things, rather what make us who we are individually. My biases are simply a starting reference point based on my life of experiences. Where we may go off rail is to allow these biases to block understanding, compassion, insight (seeking to see the heart of another).

When I “Googled” US population racial make up, U.S. census bureau 2010 reveals our country is actually 72.4% white…that’s 7 out of every 10 people. The fact that our profession is 80% white seems not far off from this national average. (Remaining data had African American at 12.6%, Asian at 4.8%. It listed Hispanic/Latin American separately at 16.3% as Latin America actually comprises many different races.).

Additionally, by God’s grace, we live in a country in which we are free to choose what ever profession we desire. The problem may not be in the exclusion of certain people based on their genetics. Could it possible be in the idea that people are poorly directed to determine their own passions, desires, individual “bents” which make them…them.

Personally, I went to college starting in architecture. Found out almost immediately this wasn’t what I wanted to do, now was suited to do. I drifted now aimlessly unknowing what in blue blazes direction I should go. I landed in education…for all the wrong reasons. Got my degree after 3 more years, knowing full well I didn’t want to teach, but couldn’t tolerate the idea of not having any direction. Once graduated, I bounced from job to job ranging from computer programming, to carpentry/construction and even a stint in unemployment. I actually stumbled onto the PT profession by — again — God’s providence. Fit me to a “T”.

Lastly, facts don’t always lead to truth. We could wrongly assume the facts on how our profession is made up means something it really doesn’t. I believe the profession has a long way to go to make it more inviting, interesting, able to be taken up by the masses. However, we should be careful about making “magnets” or “pathways” that — more often than not — lure people into a field for all the wrong reasons.

Just like my practice which I grow simply by word of mouth and reputation, our field could and should embrace the same. I’m more confident we’ll then attract the right people for the right reasons. In the long run, this only raises our profession in it’s reputation, effectiveness, efficiency and quality.

Hi Paul
Thanks for the thoughtful response. I am a huge fan of cognitive diversity which you refer to as how we see the world based on our experiences and upbringing. This is a very important part of diversity and I think we have done a good job of bringing that into the mix as I know there are quite of few PTs that have started their careers in other fields and then end up in PT. But that still does not change the “face” of what PT looks like and that is critically important to being able to truly connect with our patients. Its definitely something that the APTA and our academic system should be making efforts to change and affect.

PT does seem to have a diversity problem no matter what city or state I’ve been in and no matter the racial or cultural makeup of that place, and I’ve traveled around the country on contracts. It’s possible that this is due to lack of awareness (I certainly did not know what physical therapy was before I saw it in my school’s course catalog). And almost everywhere I’ve been I’ve been either the only person of color or the only black person. It seems to me that diversity has to be an active endeavor and not something we just ponder every once in a while.

Hey Reginald…
I hear what you’re saying. It made me think about what we’re sensitive to (meaning what our nervous system picks up and determines as meaningful from one moment to the next). Here’s a great example (to me at least)…

I was sitting in our PT break room the other day…the only male. 7 female PT/PTA/ST/OT/OTA’s with me in the break room with me.

I didn’t see that as a diversity problem at all (that definitely isn’t representative of the country’s percentages of female vs male which hovers as close to 50% as you can get). It simply is what it is. Nothing more, nothing less.

We have a lot of females working in our department…
10 years ago, we had a lot of males working in our department.

I’m just not sure it means anything meaningful. It’s simply a statistic.

Facts don’t always lead to truth.
The nervous system gathers millions of bits of information on a millisecond by millisecond basis, transmitting them to the brain for the brain to sort out as to what is meaningful and important to itself and the body at that moment, and what is not.

And this wondrous system — more powerful than the sun — flexes and changes and adapts based on all of the information coming into it on a moment by moment basis…constantly adjusting what has meaning and what does not.

That makes us all individual…different. Some differences are more obvious than others…some carry more meaning at one moment, only to have no meaning in the future moments.

We change. Life moves on…always with the meaning we assign it…always in pursuit of purpose of some sort.